Maternal and Child Health Journal

, Volume 19, Issue 2, pp 362–372 | Cite as

Prevalence and Risk Factors for Postpartum Depression Symptoms Among Women with Disabilities

  • Monika Mitra
  • Lisa I. Iezzoni
  • Jianying Zhang
  • Linda M. Long-Bellil
  • Suzanne C. Smeltzer
  • Bruce A. Barton


The adverse consequences of postpartum depression on the health of the mother and her child are well documented. However, there is little information on postpartum depression among mothers with disabilities. This study examines the patterns of depression and depressive symptoms before, during and after pregnancy and the association between depression before and during pregnancy and postpartum depression symptomatology (PPD) among women with and without disabilities. Data from the 2009–2011 Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed in 2013. Almost 30 % (28.9 %; 95 % CI 22.8–35.8) of mothers with disabilities reported often or always feeling down, depressed or sad after childbirth compared to 10 % of those without disabilities (95 % CI 8.9–11.3). Compared to other women in the study, women with disabilities had a greater likelihood for PPD symptoms (RR 1.6, 95 % CI 1.1–2.2) after accounting for sociodemographics, maternal characteristics related to PPD, and depression before and during pregnancy. Adjusting for other covariates, self-reported prenatal diagnosis of depression was not associated with symptoms of PPD and depression during pregnancy was marginally associated with PPD symptomatology for women with disabilities. Women with disabilities are at a greater risk of experiencing symptoms of postpartum depression than other women. Screening for PPD among new mothers with disabilities and timely referral of those with PPD diagnosis are vital to the health of mothers with disabilities and their children.


Disability Postpartum depression Women with disabilities Pregnancy 


  1. 1.
    Signore, C., Spong, C. Y., Krotoski, D., Shinowara, N. L., & Blackwell, S. C. (2011). Pregnancy in women with physical disabilities. Obstetrics and Gynecology, 117(4), 935.PubMedCrossRefGoogle Scholar
  2. 2.
    Smeltzer, S. C. (2007). Pregnancy in women with physical disabilities. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 36(1), 88–96.PubMedCrossRefGoogle Scholar
  3. 3.
    Iezzoni, L. I., Yu, J., Wint, A. J., Smeltzer, S. C., & Ecker, J. L. (2013). Prevalence of current pregnancy among US women with and without chronic physical disabilities. Medical Care, 51(6), 555–562.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Walsh-Gallagher, D., Sinclair, M., & Mc Conkey, R. (2012). The ambiguity of disabled women’s experiences of pregnancy, childbirth and motherhood: A phenomenological understanding. Midwifery., 28(2), 156–162.PubMedCrossRefGoogle Scholar
  5. 5.
    Chakravarty, E. F., Nelson, L., & Krishnan, E. (2006). Obstetric hospitalizations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis and Rheumatism, 54(3), 899–907.PubMedCrossRefGoogle Scholar
  6. 6.
    Rogers, J., & Matsumura, M. (2005). The disabled woman’s guide to pregnancy and birth. New York City: Demos Medical Publishing.Google Scholar
  7. 7.
    Kelly, V. M., Nelson, L. M., & Chakravarty, E. F. (2009). Obstetric outcomes in women with multiple sclerosis and epilepsy. Neurology., 73(22), 1831–1836.PubMedCrossRefGoogle Scholar
  8. 8.
    Bruce, M. L., Seeman, T. E., Merrill, S. S., & Blazer, D. G. (1994). The impact of depressive symptomatology on physical disability: MacArthur studies of successful aging. American Journal of Public Health, 84(11), 1796–1799.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Turner, R. J., & Noh, S. (1988). Physical disability and depression: A longitudinal analysis. Journal of Health and Social Behavior, 29(1), 23–37.PubMedCrossRefGoogle Scholar
  10. 10.
    MacDonald, M. R., Nielson, W. R., & Cameron, M. G. (1987). Depression and activity patterns of spinal cord injured persons living in the community. Archives of Physical Medicine and Rehabilitation, 68(6), 339–343.PubMedGoogle Scholar
  11. 11.
    Fullerton, D. T., Harvey, R. F., Klein, M. H., & Howell, T. (1981). Psychiatric disorders in patients with spinal cord injuries. Archives of General Psychiatry, 38(12), 1369–1371.PubMedCrossRefGoogle Scholar
  12. 12.
    Vahle, V. J., Andresen, E. M., & Hagglund, K. J. (2000). Depression measures in outcomes research. Archives of Physical Medicine and Rehabilitation, 81(12 Suppl 2), S53–S62.PubMedCrossRefGoogle Scholar
  13. 13.
    Disability and Health Data System (DHDS). (2013).
  14. 14.
    Chevarley, F. M., Thierry, J. M., Gill, C. J., Ryerson, A. B., & Nosek, M. A. (2006). Health, preventive health care, and health care access among women with disabilities in the 1994–1995 national health interview survey, supplement on disability. Womens Health Issues, 16(6), 297–312.PubMedCrossRefGoogle Scholar
  15. 15.
    Centers for Disease Control and Prevention. (2008). Morbidity and mortality weekly report (MMWR). Prevalence of self-reported postpartum depressive symptoms—17 states, 2004–2005. CDC 57(14).Google Scholar
  16. 16.
    Goodman, J. H. (2004). Postpartum depression beyond the early postpartum period. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 33(4), 410–420.PubMedCrossRefGoogle Scholar
  17. 17.
    Vigod, S. N., Villegas, L., Dennis, C. L., & Ross, L. E. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: A systematic review. BJOG, 117(5), 540–550.PubMedCrossRefGoogle Scholar
  18. 18.
    Beck, C. T. (1998). The effects of postpartum depression on child development: A meta-analysis. Archives of Psychiatric Nursing, 12(1), 12–20.PubMedCrossRefGoogle Scholar
  19. 19.
    Luoma, I., Tamminen, T., Kaukonen, P., Laippala, P., Puura, K., Salmelin, R., et al. (2001). Longitudinal study of maternal depressive symptoms and child well-being. Journal of the American Academy of Child and Adolescent Psychiatry, 40(12), 1367–1374.PubMedCrossRefGoogle Scholar
  20. 20.
    Nelson, D. R., Hammen, C., Brennan, P. A., & Ullman, J. B. (2003). The impact of maternal depression on adolescent adjustment: The role of expressed emotion. Journal of Consulting and Clinical Psychology, 71(5), 935–944.PubMedCrossRefGoogle Scholar
  21. 21.
    Martins, C., & Gaffan, E. A. (2000). Effects of early maternal depression on patterns of infant-mother attachment: A meta-analytic investigation. Journal of Child Psychology and Psychiatry, 41(6), 737–746.PubMedCrossRefGoogle Scholar
  22. 22.
    Weinberg, M. K., & Tronick, E. Z. (1998). The impact of maternal psychiatric illness on infant development. Journal of Clinical Psychiatry, 59(Suppl 2), 53–61.PubMedGoogle Scholar
  23. 23.
    Marcus, S. M., & Heringhausen, J. E. (2009). Depression in childbearing women: When depression complicates pregnancy. Primary Care, 36(1), 151–165.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    O’hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression: A meta-analysis. Int Rev Psychiatry, 8(1), 37–54.CrossRefGoogle Scholar
  25. 25.
    Altshuler, L. L., Cohen, L. S., Moline, M. L., Kahn, D. A., Carpenter, D., Docherty, J. P., et al. (2001). Treatment of depression in women: A summary of the expert consensus guidelines. J Psychiatr Pract., 7(3), 185–208.PubMedCrossRefGoogle Scholar
  26. 26.
    Dennis, C. L., & Vigod, S. (2013). The relationship between postpartum depression, domestic violence, childhood violence, and substance use: Epidemiologic study of a large community sample. Violence Against Women., 19(4), 503–517.PubMedCrossRefGoogle Scholar
  27. 27.
    Dennis, C.-E., Janssen, P. A., & Singer, J. (2004). Identifying women at-risk for postpartum depression in the immediate postpartum period. Acta Psychiatrica Scand., 110(5), 338–346.CrossRefGoogle Scholar
  28. 28.
    Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26(4), 289–295.PubMedCrossRefGoogle Scholar
  29. 29.
    Clare, C. A., & Yeh, J. (2012). Postpartum depression in special populations: A review. Obstetrical & Gynecological Survey, 67(5), 313–323.CrossRefGoogle Scholar
  30. 30.
    Rhode Island Department of Public Health. (2009–2011). Pregnancy risk assessment monitoring system (PRAMS).Google Scholar
  31. 31.
    Pregnancy Risk Assessment Monitoring System (PRAMS).
  32. 32.
    Leigh, B., & Milgrom, J. (2008). Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry. doi:10.1186/1471-244X-8-24.
  33. 33.
    Liu, C. H., & Tronick, E. (2012). Rates and predictors of postpartum depression by race and ethnicity: Results from the 2004 to 2007 New York City PRAMS survey (Pregnancy Risk Assessment Monitoring System). Maternal and Child Health Journal, 17(9), 1599–1610.Google Scholar
  34. 34.
    Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26(4), 289–295.PubMedCrossRefGoogle Scholar
  35. 35.
    Prilleltensky, O. (2003). A ramp to motherhood: The experiences of mothers with physical disabilities. Sex Disab., 21(1), 21–47.CrossRefGoogle Scholar
  36. 36.
    Nosek, M. A., Young, M. E., Rintala, D. H., Howland, C. A., Foley, C. C., & Bennett, J. L. (1995). Barriers to reproductive health maintenance among women with physical disabilities. Journal of Women’s Health., 4(5), 505–518.CrossRefGoogle Scholar
  37. 37.
    Office of the Surgeon General (US), Office on Disability (US). (2005). The Surgeon General’s call to action to improve the health and wellness of persons with disabilities. Rockville, MD: US Department of Health and Human Services.Google Scholar
  38. 38.
    Breslin, M. L., & Yee, S. (2009). The current state of health care for people with disabilities. Washington, DC: National Council on Disability.Google Scholar
  39. 39.
    Mason, M. G., & Long-Bellil, L. (2012). Taking care: Lessons from mothers with disabilities. Lanham, Maryland: University Press of America.Google Scholar
  40. 40.
    Smeltzer, S. C. (2002). Reproductive decision making in women with multiple sclerosis. Journal of Neuroscience Nursing, 34(3), 145.PubMedCrossRefGoogle Scholar
  41. 41.
    Llewellyn, G., & McConnell, D. (2002). Mothers with learning difficulties and their support networks. Journal of Intellectual Disability Research, 46(Pt 1), 17–34.PubMedCrossRefGoogle Scholar
  42. 42.
    Ross, L. E., & Dennis, C. L. (2009). The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: A systematic review. J Womens Health (Larchmt)., 18(4), 475–486.CrossRefGoogle Scholar
  43. 43.
    Larrabee, K. D., Monga, M., Eriksen, N., & Helfgott, A. (1996). Quality of life assessment in pregnant women with the human immunodeficiency virus. Obstetrics and Gynecology, 88(6), 1016–1020.PubMedCrossRefGoogle Scholar
  44. 44.
    Ethier, K. A., Ickovics, J. R., Fernandez, M. I., Wilson, T. E., Royce, R. A., Koenig, L. J., et al. (2002). The perinatal guidelines evaluation project HIV and pregnancy study: Overview and cohort description. Public Health Reports, 117(2), 137–147.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Chaaya, M., Campbell, O. M., El Kak, F., Shaar, D., Harb, H., & Kaddour, A. (2002). Postpartum depression: Prevalence and determinants in Lebanon. Arch Womens Ment Health., 5(2), 65–72.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Forger, F., Ostensen, M., Schumacher, A., & Villiger, P. M. (2005). Impact of pregnancy on health related quality of life evaluated prospectively in pregnant women with rheumatic diseases by the SF-36 health survey. Annals of the Rheumatic Diseases, 64(10), 1494–1499.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Weinberg, M. K., & Tronick, E. Z. (1998). The impact of maternal psychiatric illness on infant development. Journal of Clinical Psychiatry, 59(Suppl 2), 53–61.PubMedGoogle Scholar
  48. 48.
    Thomas, C., & Curtis, P. (1997). Having a baby: Some disabled women’s reproductive experiences. Midwifery., 13(4), 202–209.PubMedCrossRefGoogle Scholar
  49. 49.
    Mitra, M., Lu, E., & Diop, H. (2012). Smoking among pregnant women with disabilities. Womens Health Issues., 22(2), e233–e239.PubMedCrossRefGoogle Scholar
  50. 50.
    Mitra, M., Manning, S. E., & Lu, E. (2012). Physical abuse around the time of pregnancy among women with disabilities. Maternal and Child Health Journal, 16(4), 802–806.PubMedCrossRefGoogle Scholar
  51. 51.
    Lipson, J. G., & Rogers, J. G. (2000). Pregnancy, birth, and disability: Women’s health care experiences. Health Care for Women International, 21(1), 11–26.PubMedCrossRefGoogle Scholar
  52. 52.
    Blackford, K. A., Richardson, H., & Grieve, S. (2000). Prenatal education for mothers with disabilities. Journal of Advanced Nursing, 32(4), 898–904.PubMedGoogle Scholar
  53. 53.
    Andrade, S. E., Scott, P. E., Davis, R. L., Li, D. K., Getahun, D., Cheetham, T. C., et al. (2013). Validity of health plan and birth certificate data for pregnancy research. Pharmacoepidemiology and Drug Safety, 22(1), 7–15.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Kane, D. J., & Sappenfield, W. M. (2014). Ascertainment of medicaid payment for delivery on the Iowa birth certificate: Is accuracy sufficient for timely policy and program relevant analysis? Maternal and Child Health Journal, 18(4), 970–977.PubMedCrossRefGoogle Scholar
  55. 55.
    Mason, L. R., Nam, Y., & Kim, Y. (2014). Validity of infant race/ethnicity from birth certificates in the context of U.S. demographic change. Health Services Research, 49(1), 249–267.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Monika Mitra
    • 1
  • Lisa I. Iezzoni
    • 2
  • Jianying Zhang
    • 1
  • Linda M. Long-Bellil
    • 1
  • Suzanne C. Smeltzer
    • 3
  • Bruce A. Barton
    • 4
  1. 1.Center for Health Policy and ResearchUniversity of Massachusetts Medical SchoolShrewsburyUSA
  2. 2.The Mongan Institute for Health PolicyMassachusetts General HospitalBostonUSA
  3. 3.Center for Nursing ResearchVillanova UniversityVillanovaUSA
  4. 4.Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterUSA

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